Individual
MRS. JANICE MARIE DE SMIDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
5595 COUNTY ROAD Z, WEST BEND, WI 53095-9224
(262) 306-2100
(262) 306-2151
Mailing address
272 E MERRILL AVE, FOND DU LAC, WI 54935-3616
(920) 926-0144
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1074-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01112123
ASHA MEMBERSHIP
—
05
—
42760100
—
WI
Enumeration date
07/20/2006
Last updated
07/08/2007
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